Mount Sinai School of Medicine, Health Policy, New York, NY 10029, USA.
J Oncol Pract. 2013 May;9(3):e81-5. doi: 10.1200/JOP.2012.000843.
As adjuvant treatment moves to outpatient settings, required reporting is problematic. We undertook a solutions-focused exercise to identify reporting barriers and devise a pilot improvement intervention.
We convened a multidisciplinary group of community-based oncologists, tumor registry (TR) staff, and hospital leadership. The group identified three key barriers to reporting: (1) inability to identify correct managing physician, (2) poor communication, and (3) manual reporting burden. Our intervention addressed the first two barriers and involved correcting physician contact information, simplifying contact forms, ascertaining cases in real time, and priming physician office staff to respond to TR requests.
Preintervention, the TR did not identify any pilot patients' managing medical oncologists and little adjuvant treatment. During the April-May 2012 intervention, 22 patients with breast cancer listed our volunteer surgeon as managing physician. The TR sent 22 treatment letters to the surgeon's office and received 19 (86%) responses identifying the managing medical oncologist. Nine of the 19 cases (47%) were closed. To close a case required an average of 5.9 contacts and 28 minutes for electronic medical record-based cases and 38.9 minutes for community oncology cases. Sixty-four percent of required treatment was reported. Surgical staff spent ~0.5 hours per case to identify the oncologist prescribing adjuvant treatment.
The solutions-focused exercise improved identification of managing oncologists from 0% to 86% for patients treated by community oncologists. Treatment reporting increased from 2.6% to 64%. The pilot did not address the burden of reporting, which remains great. Electronic records can reduce this burden, but this approach is not currently feasible for many oncologists.
随着辅助治疗转移到门诊环境，所需的报告存在问题。我们进行了一项以解决方案为重点的练习，以确定报告障碍并设计一个试点改进干预措施。
我们召集了一组多学科的社区肿瘤学家、肿瘤登记处（TR）工作人员和医院领导。该小组确定了报告的三个关键障碍：（1）无法识别正确的主治医生，（2）沟通不畅，（3）手动报告负担。我们的干预措施解决了前两个障碍，包括纠正医生的联系信息、简化联系表格、实时确定病例以及向医生办公室工作人员预先告知以响应 TR 请求。
在干预前，TR 无法识别试点患者的主治医疗肿瘤学家和辅助治疗情况。在 2012 年 4 月至 5 月的干预期间，22 名乳腺癌患者将我们的志愿外科医生列为主治医生。TR 向外科医生办公室发送了 22 份治疗信件，收到了 19 份（86%）回复，确定了主治医疗肿瘤学家。19 例中有 9 例（47%）结案。关闭一个病例平均需要 5.9 次联系和 28 分钟的电子病历，而社区肿瘤病例则需要 38.9 分钟。需要的治疗有 64%得到了报告。外科工作人员花费约 0.5 小时/例来识别开处辅助治疗的肿瘤学家。
以解决方案为重点的练习将社区肿瘤学家治疗的患者中主治肿瘤学家的识别率从 0%提高到 86%。治疗报告从 2.6%增加到 64%。该试点并未解决报告负担问题，这仍然很大。电子记录可以减轻这种负担，但这种方法目前对许多肿瘤学家来说不可行。
